Provider Demographics
NPI:1699839688
Name:CORBY, BRIAN JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:CORBY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WARREN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1057
Mailing Address - Country:US
Mailing Address - Phone:212-946-5124
Mailing Address - Fax:212-645-9449
Practice Address - Street 1:983 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0808
Practice Address - Country:US
Practice Address - Phone:917-445-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY547002OtherVALUEOPTIONS INS PROV #